For us to be able to go to hospitals and offer our software services with no huge upfront investment—this is revolutionary for them. We’re passing on the same payment models that AWS offers us, and in the process enabling hospitals large and small to take advantage of a ground-breaking new technology.

UK clinical applications firm
Cydar, formed in 2012 as a spin-off from Kings College London and Guy’s and St. Thomas’ hospitals, provides advanced 3D visualization techniques and cloud-based high-performance computing. Its technology allows live x-ray images to be matched up with 3D images such as CT scans, giving surgeons in the operating theater access to real-time information that increases the chances of successful patient outcomes.

After spending a number of years developing its core technology,
Cydar
reached a stage in 2012 where the software was working on a large single server. However, any updates to the overlay took minutes to complete and all other processes would grind to a halt. It was imperative to find a way to update the overlays in less than five seconds. The obvious solution was to add servers.

Being a private and grant-funded operation, getting the right cost and pricing model for its IT investment was important for Cydar, so building its own data center was ruled out due to the huge capital expenditure involved. Tom Carrell, chief executive officer and cofounder of Cydar—also a consultant vascular surgeon—says, “To take the next step in getting our product to market, we needed massive computing power and the ability to scale rapidly, and we needed to do this cost-effectively and without significant upfront investment.”

“Strong graphics processing unit support was key,” adds John Clarke, CTO at
Cydar.
“With the scale of processing we were doing, it had to be GPU-accelerated.”

“We chose AWS because it’s a big player, and it made it really easy for us to get started,” says Carrell. “We could sign up, give our credit card details, and get almost instant access to GPU servers and start developing.”

Cydar is using Amazon Virtual Private Cloud (Amazon VPN) for its secure virtual cloud, Amazon Elastic Compute Cloud (Amazon EC2) GPU servers provide the massive compute power it requires, and Amazon Simple Storage Service (Amazon S3) provides data storage. Clarke says, “We’re currently holding data from several hundred cases in Amazon S3. It’s an incredibly cost-effective way for us to store vast amounts of patient information. In terms of
compute
, we take advantage of EC2 Spot Instances, which have been a real revelation and suit the way we operate.”

He continues, “One of the unexpected things for us was AWS Marketplace. Many of our customers want to use VPNs to connect, which can be tricky. Our ability to find esoteric solutions in the AWS Marketplace—for example, a server that will connect to a particular VPN—was absolute gold for us. The breadth and scope of the marketplace were a very pleasant surprise.”

The development and build began in June 2014. Within three months of deciding to go with AWS,
Cydar
was hosting the first cloud-based surgeries.

“Although initially AWS was the obvious choice, we’ve since stacked up many reasons why it was the right choice for us—not least because of its performance, scale, and pricing,” says Clarke. “And security, of course.” For
Cydar
, using AWS Identity and Access Management (IAM) and AWS Multi-Factor Authentication is key to creating the robust security its clients require. Clarke continues: “Everything is all trackable and visible—much more so than it would be in physical boxes under our own roof.”

Carrell emphasizes just how important it is that healthcare organizations trust
Cydar
with their data. “If we couldn’t directly demonstrate the security of the cloud, it would mean a complete halt to operations. Being able to point not only to AWS ISO 27001 certification but also to the fact that we’re within a government-approved G-cloud in the UK, means that we have the answers to questions around security before the hospital even raises them. It reassures the hospitals and it also reassures our investors. Everyone’s happy,” he says.
Cydar
is confident that it will overcome these same security concerns at hospitals in the US when the time comes. “As we start to consider the US market, the HIPAA support from AWS is going to be vital,” says Clarke.

Massive scale and the ability to make the most of its computing resources are essential for the company’s medical device to work seamlessly. “Our software is incredibly bursty,” says Carrell. “We only need high-performance computing in the operating room during each image processing burst, which happens every couple of minutes or so and lasts about five seconds. The beauty of AWS and the cloud is that we can use the computing power across a number of operating theaters at the same time and fully optimize our resources. It’s turned the potentially problematic, bursty nature of the software into an advantage.”

Like all small businesses with big ambitions, cash flow is a priority. Here, again, the cloud pricing model is an enabler for
Cydar
. Carrell says: “Through our dashboard, we know exactly what we’re spending. The ability to scale rapidly with AWS without having to plow enormous amounts of cash into the solution gives us
real
agility
to take our technology forward. To create this sort of compute
power
ourselves would have been a prohibitively expensive and time-consuming project. Essentially, from day one, we saved about £200,000 and countless hours of development time.”

He continues: “It’s no exaggeration to say that our technology has the potential to change the way healthcare providers work. These organizations
are
used to
capital expenditure
-based models of investment, which makes it difficult for them to do innovative things that could ultimately improve patient outcomes. For us to be able to go to hospitals and offer this as a service with no huge upfront investment—this is revolutionary for them. We’re passing on the same payment models that AWS offers us and in the process enabling hospitals large and small to take advantage of a ground-breaking new technology. For many of them, it’s the difference between being able to do it or not.”

Cydar
is keen to use the extensive knowledge it has gained to support other innovative projects. “We know there are companies that are in the early stages of using cloud supercomputing to develop medical devices,” says Carrell. “Given the experience we’ve amassed, it would be brilliant if we could help them in their journeys. We have
real
potential here to make science work harder for healthcare and make a genuine difference to patient outcomes.”